Healthcare Provider Details

I. General information

NPI: 1164849899
Provider Name (Legal Business Name): BETHANY L. GOTTESMAN BOWEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY GOTTESMAN

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E CAMBRIDGE AVE
PHOENIX AZ
85006-1459
US

IV. Provider business mailing address

2108 E THOMAS RD
PHOENIX AZ
85016-7761
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0935
  • Fax:
Mailing address:
  • Phone: 602-933-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA156739
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA156739
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number52072
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA156739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: